Provider Demographics
NPI:1245388370
Name:AZARIAN, ANAIT (PHD)
Entity Type:Individual
Prefix:
First Name:ANAIT
Middle Name:
Last Name:AZARIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2902
Mailing Address - Country:US
Mailing Address - Phone:401-829-1964
Mailing Address - Fax:401-270-3740
Practice Address - Street 1:1 RICHMOND SQ
Practice Address - Street 2:102K
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:401-751-3281
Practice Address - Fax:401-270-3740
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI232267OtherBLUE CROOS AND BLUE SHIEL
RI1037250OtherBEACON HEALTH STRATEGIES
RI407745OtherBLUE CHIP
RIAA37210Medicaid
RI689003621Medicare ID - Type Unspecified